Calcium Supplementation "Compass" - "Guidelines for the Diagnosis and Treatment of Osteoporosis in China (2023)"


Osteoporosis is a bone disease associated with aging, and its incidence increases with age. The National Health Commission released the results of the first Chinese osteoporosis epidemiologic survey in October 2018, showing that osteoporosis has become an important health problem for China's middle-aged and elderly population. Calcium supplementation for elderly osteoporosis patients has become urgent, and the newly released “Guidelines for the Diagnosis and Treatment of Senile Osteoporosis in China (2023)” provides clear recommendations on how to supplement calcium for elderly osteoporosis patients:


(1)Calcium and vitamin D deficiencies are common in older patients with osteoporosis. Combined supplementation of calcium and vitamin D can increase bone mineral density in the lumbar spine and femoral neck, and slightly reduce the risk of hip fracture. The total daily intake of elemental calcium in elderly osteoporosis is 1,000~1,200 mg, and the tolerable maximum is 2,000 mg. In addition to dietary supplementation, supplemental elemental calcium of 500~600 mg is needed every day, and the selection of calcium supplements needs to take into account the content, safety, efficacy, and compliance of elemental calcium. (1B)(2)Calcium is contraindicated in patients with hypercalcemia or hyperuricemia. (1C)

Rationale for Recommendation

Calcium and vitamin D are important elements for maintaining bone health. The Dietary Guidelines for Chinese Residents (2022) recommends a daily calcium intake of 1,000 mg for the elderly (>65 years old), and the Guidelines for the Diagnosis and Treatment of Primary Osteoporosis (2022) suggests a daily intake of 1,000-1,200 mg of elemental calcium for middle-aged and elderly people aged 50 years or older; however, the daily dietary intake of calcium in the Chinese population is usually low. Therefore, calcium intake can be increased by drinking milk or taking calcium supplements to reach a total calcium intake of 800-1,200 mg/d. Studies have shown that the intake of dairy products, calcium, and vitamin D has a positive impact on improving bone density and reducing the risk of fracture. Dairy intake has been associated with increased bone density in the lumbar spine, femoral neck, total hip, and total body. If dietary calcium intake is insufficient, calcium supplements are available. However, it is important to be aware of the absorption rates and possible side effects of various calcium supplements, as detailed in the table below.

Calcium Supplementation

Table 2 Recommendations for calcium supplementation in elderly patients with osteoporosis.

Laboratory Tests for Osteoporosis

Laboratory tests for osteoporosis often include:

Blood routine, urine routine, liver function, kidney function,

25-hydroxyvitamin D (25-OHVD),

parathyroid hormone (PTH) levels.

Bone Metabolism Markers



Parathyroid hormone (PTH):

PTH is a calcium-regulating hormone secreted by parathyroid master cells, and its main physiological role is to elevate blood calcium and lower blood phosphorus: the concentrations of blood calcium and blood phosphorus, in turn, affect the secretion of PTH through a feedback mechanism. When blood calcium decreases, PTH secretion will be prompted; when blood calcium increases, PTH secretion will be inhibited; in addition, PTH also has a promotional effect on the formation of osteoclasts, which enhances osteolysis and promotes the elevation of blood calcium. Therefore, high PTH level will enhance osteoclast activity, resulting in stronger bone resorption than bone formation, and osteolysis induced osteoporosis. Therefore, if the patient's parathyroid hormone (PTH) is significantly elevated, further examination is needed to determine whether the osteoporosis is secondary to hyperparathyroidism.


25-hydroxyvitamin D (25-OHVD):

Vitamin D is an indispensable vitamin and nutrient in the human body, which not only regulates calcium and phosphorus metabolism, but also promotes the regulation of calcification of bones, and facilitates the formation and growth of bones. 25-OHVD can be measured to know whether the body is deficient in vitamin D. It is relatively stable in the human body with a high concentration, which is not affected by the blood levels of calcium and parathyroid hormone, and reflects the total amount of vitamin D consumed by food and synthesized by the body, as well as the ability to convert vitamin D. The concentration of vitamin D in the human body is high, and is not influenced by blood levels of calcium and parathyroid hormone. It reflects the total amount of vitamin D consumed in food and synthesized by the body, as well as the ability to convert vitamin D. In addition, when 25-OHVD level decreases, it will affect the body's absorption of calcium ions, which in turn will hinder bone mineralization and bone matrix formation, and ultimately lead to osteoporosis. 25-OHVD concentration is widely recognized as a better indicator to objectively evaluate vitamin D level.

25-OHVD has a protective effect against osteoporosis, and PTH is a risk factor for the occurrence of osteoporosis. The combination of the two tests can evaluate and monitor the changes in bone metabolism, and has the advantages of reflecting the changes in bone turnover in a sensitive, rapid and dynamic manner, and is therefore widely used in the clinic.

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Calcium Supplementation

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